New Tools Clarify Transitional Care Management CPT Codes

Family physicians who serve Medicare patients are scrambling to understand the intricacies of two new CPT codes created to cover transitional care management (TCM) services. Specifically, codes 99495 and 99496 were approved by CMS last fall and became available to physician practices in January.

The CPT codes cover services provided when a patient's condition requires moderate- (99495) or high-complexity (99496) medical decision-making as the patient is transitioning from inpatient hospital care to his or her home or another community setting.

The AAFP has created two free tools to help members get comfortable assimilating the new codes into their billing processes.

The worksheet also helps physicians assess and tabulate the level of their medical decision-making -- be it moderate or high -- during a patient's care transition.

The last line on the form reminds FPs to submit billing 30 days after the patient's discharge.

Physicians also may find it helpful to review two entries about payment for transitional care management that were published in Family Practice Management's Getting Paid blog. The most recent blog entry posted on Feb. 12 and details some situations that have caused confusion since the codes went into effect, and a Nov. 29 blog post announces the new codes and provides a basic overview.